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CISM Annual Report 2015 v1.2 (2)
- 1. American Medical Response Critical Incident Stress Management Program March 17, 2015 December 31, 2015 Annual Report Serving Clark, Cowlitz, Clackamas, and Multnomah County Operations, Communications, Special Services Division, and Special Teams Prepared by Bill Lang, B.A., Paramedic, CISM Coordinator Submitted October 12, 2016
- 2. Introduction This Second Annual Report of the Critical Incident Stress Management Program provides a synopsis of the program for the period of March 17, 2015 to December 31, 2015. Using this time period will bring future annual reports into alignment with the fiscal year and reporting timeline used by the company. Because the report includes less than a full year's activity, the statistics may lower than what were reported in the previous Annual Report. This report includes the following: Acknowledgements Mission statement, goals, and objectives General update Action Log spreadsheet documenting the actions taken by those involved in the Program Glossary of terms and abbreviations Mock CISM Activation Scenario Components for future program development Please note that any mention within this report of American Medical Response (AMR) is in reference to the Company's Operations located in Multnomah and Clackamas Counties in Oregon as well as Clark and Cowlitz Counties in Washington State. This Program currently has no formal function in any other operation within American Medical Response. Acknowledgments CISM/Peer Support is a community effort, and as such, is dependent upon the support of everyone in an organization. During this second year of the program a number of folks have been generous with their time, effort, personal skills, and moral support. Therefore, I would like to acknowledge and thank the following people: Randy Lauer, General Manager for AMR NW Oregon and SW Washington, who took the risk of allowing a street medic to function as coordinator of the program and secured the funds necessary to get the project off the ground; Paul Priest, former Director of Operations in Multnomah and Clackamas Counties, who gave approval for providing catered lunches at team meetings, shift coverage for team meetings, pre-incident education presentations, and office work days for the coordinator; Liz Upton, Administrative Assistant for Multnomah County Operations, who arranged to have meals provided for the CISM Team during meetings and reserved meeting space; the folks at the International Critical Incident Stress Foundation (ICISF), who have provided a template for this program; Drew Prochniak, LPC, who has been generous with his time and moral support of the program without which the program would not exist. Drew has ridden with crews in the field on his own time; and Tina Beeler, Clackamas County Operations Training Officer who made time available to provide pre-incident education at the New Employee Orientations throughout the year; Tim Case, Multnomah County Operations Training Officer who made time available to begin pre-incident education for existing employees; and Mark Prinzmetal, Multnomah County Operations Supervisor, who found a way to notate each peer counselor's name in the Telestaff time keeping program with 'CISM,' making it easier for supervisor's to locate peer counselors when activations are requested. The back bone and worker bees of this program continue to be the members of the CISM Team: Jeff Beck, Lori Moorison, Alice' Hall, Julie Bolt, Mark Jones, Ed Palmer, Gary Laurent, Aaron Botteron, Mary Watson, Derek Stekhuizen, Jody Caprino, and Lewis Coleman. These folks continue to face the same perplexing situations in the performance of their duties as the peers they seek to support. The peer counselors are exposed to all of the same critical incident stress, cumulative stress, and the stresses of their personal lives all the while making themselves available to their peers when the chips are down. The program exists because they said 'yes' to providing this service.
- 3. Program Mission The mission of the CISM Program is to provide crisis intervention and peer support, access to culturally competent Professional Mental health services, and critical incident and cumulative stress education for Emergency Medical Services (EMS) field, communications, and management personnel and their family members/significant others. Program Goals The program shall assist employees in the management and reduction of the negative effects of acute psychological stress due to exposure to critical incidents and cumulative stress due to chronic exposure to generally stressful situations encountered in the EMS work environment. The program shall provide education for EMS field employees, Communications employees, Management, and their family members/significant others on the subject of critical incident stress, cumulative stress, symptomology of stress, and strategies to manage stress. The program shall provide barrier free access to culturally competent professional mental health services. Program Objectives The program shall develop and maintain a CISM Team which includes representatives from Operations, Management, and Communications, a Program Coordinator, and a Mental Health Professional. This team shall be trained in crisis intervention and peer support using curriculum developed by the International Critical Incident Stress Foundation. Team members shall be identified by soliciting nominations from operations, communications, and management along with endorsement from management. Team members shall be available while on duty to offer peer support and defusing of critical incidents. The CISM Team shall meet at least semiannually for the purposes of Professional Mental Health oversight, continuing education, and mutual support. The program shall be lead by a coordinator who will provide program development and administration as well as educational and moral support for the CISM Team. The program shall develop and maintain a formal relationship with a Licensed Mental Health Professional (MHP) from the communities served by the company. The MHP shall be (or become) culturally competent and shall be established as a provider in the Company's EAP for the purposes of reimbursement. The MHP shall be given the opportunity to participate in ride alongs in the field and shall have access to Company facilities. The program shall develop and present Pre-incident Educational opportunities for employees via New Employee Orientation and other continuing education venues offered by the Company. The program shall develop specialized support services for employees who are veterans of the military in conjunction with the Veterans Administration. The program shall develop specialized support services and educational opportunities for family members/significant others of employees in the understanding and management of critical incident and cumulative stress.
- 4. General Update During this past year we sadly said good-bye to Niccole Beauleaurier, Clark County Paramedic as she earned her B.S.N. and is now working in the Emergency Department at Peace Southwest Medical Center in Vancouver, WA. Niccole is working with hospital administration to establish a CISM/Peer Support Program at Peace Southwest. We wish her well in her new endeavor. The scheduling of team meetings has proved to be difficult with the many logistical challenges of the EMS system demands, personnel coming from four counties and beyond, and attempting to find the day within a two week period which had the least number of team members on duty, made for an arduous process for the planning of team meetings. Fortunately, approval was given to set permanent dates for the entire year. It proved to be unfeasible to hold team meetings on a quarterly basis. Semiannual meetings were a workable compromise. It has been established and approved by management that team meetings are to be held on the second Tuesday of May and November each year. This will aid in planning and increasing attendance. Progress has been made in the delivery of Pre-incident education in large part due to the efforts of Aaron Botteron, Paramedic, Peer Counselor. Aaron has taken on much of the responsibility of presenting at New Employee Orientation and the River Rescue Academy. Aaron has also put a great deal of work into researching the effects of psycho/emotional trauma on the human brain as well as the effects of psycho/emotional trauma among those experiencing poverty. An increase in the utilization of the services of the mental health professional through the company's EAP vendor has been noted Drew Prochniak, LPC. While the rates of use and identities of those utilizing professional mental health services are not recorded by the company and remain confidential, the occurrence of employees speaking about utilizing this benefit has become increasingly common. Drew Prochniak, LPC, continues to partner with the program and has been a positive influence on many in the workforce through the therapy he provides, working with peer counselors, and participating in ride alongs. This has aided in changing the culture of the workforce to more openly embrace mental health counseling as a valuable resource. The identification of critical incident exposures as they occur continues to be a daunting challenge. It has become increasingly obvious that it is not humanly possible for on duty supervisors to be aware of all critical incidents as they take place. Supervisors must often commit their full attention to other tasks and are unable to constantly monitor the radio. A meeting was held with managers from Operations, Communications and the coordinator to attempt to bring the activation procedure to the Communications Center. This creates challenges related to Communications Center employee workload and the apparent limitations of CAD software programs to streamline the process of identification of critical incidents, locating a peer counselor, and then activating them. Communications Center personnel agreed to study the matter further and report back to Operations and the coordinator.
- 5. Summary of Action Log March 17, 2015 to December 31, 2015 Offers of Peer Support made by Supervisor: 7 Peer Counselor Contacts with Employees: 22 Defusings conducted: 21 Follow-Up Calls made by Peer Counselors: 13 Referrals to MHP by Peer Counselors: 0 (Without additional services) MHP Ride Along: 1 Team Meetings held: 2 Pre-incident Education provided- New Employee Orientation Classes: 4 River Rescue Academy: 1
- 6. Glossary of Terms for CISM Action Log Shaded fields- Actions in Brown: MHP ride along Actions in Grey: Actions performed before the official launch of the current Program. Actions in Blue: Team development such as Team meetings for the purpose of mutual support, continuing education, interaction with the MHP. Actions in Green: Actions having to do with Pre-incident Education. Includes presentations on CISM at New Employee Orientation, Continuing Education In-services, and other venues where education on crisis intervention, peer support, mental health therapy and information about the CISM Program are presented. Abbreviations- LPC: Licensed Professional Counselor. One of several credentialed Mental Health Professionals. MHP: Mental Health Professional. Can be a LPC or other Mental Health Professional such as a Licensed Clinical Social Worker. MVC: Motor Vehicle Crash MCI: Mass Casualty Incident NEO: New Employee Orientation Sup: Supervisor. In this case, EMS Supervisor. PC: CISM Team Peer Counselor. EMS personnel and EMS supervisors trained in crisis intervention. PCs provide psychological first aid to coworkers. Ld: Lead. In this case Lead Paramedic Code/ Ped Code: Cardiac arrest/ cardiac arrest involving a child FF: Fire Fighter + symbol Indicates an additional, unrelated issue issue TBGJ: Testify Before Grand Jury
- 7. Glossary of Terms for Action Log (Continued SERT: Special Emergency Response Team (Law Enforcement) Xport: Transport by ambulance. Terms- Contact: When a peer counselor contacts an employee in person, telephonically, via text or email, offering peer support. Defusing: An informal meeting between a peer counselor and 1-4 employees for the purpose of providing peer support, stabilization, acknowledgment of a critical incident, facilitation of understanding of stress symptoms, management of stress, and referral to a mental health professional, if indicated. Follow Up: Contact made by a peer counselor with an employee withing one week after a defusing with a three part question; 'How are you doing? Better, worse, or about the same?' Assessment for the need of additional services is made at this time. MHP Ride Along: When the mental health professional rides with an ambulance crew in the field for the purpose of getting to know employees and gaining first hand knowledge of the EMS work environment. This is an opportunity for the MHP to develop cultural competency and for EMS personnel to understand the work and role of the MHP in CISM. Offer: Offers to activate a peer counselor for defusing/peer support made by a Supervisor but the employee declines the offer.
- 8. CISM Action Log March 17, 2015 December 31, 2015 DATE ACTIONTYPE PEER COUNSELOR NATURE MODE REPORTER #OFPERSONNEL 03/17/15 Contact Ed Palmer MCI phone coordinator 2 03/17/15 Follow-up Lewis Coleman adolescent suicide/hanging phone PC 2 03/17/15 Bill Lang intro to CISM-NEO in person 12 03/21/15 Offer Shawn Hunt (sup) premature birth in person Supervisor 2 04/02/15 Contact Julie Bolt in person PC 2 04/03/15 Defusing Bill Lang Terminal Cancer/Hostile Family in person Supervisor 1 04/03/15 Follow-up Bill Lang Terminal Cancer/Hostile Family phone PC 1 04/21/15 Offer Tim Case (Sup) Critical Pediatric in personin person Supervisor 2 04/22/15 CISM Team Meeting 05/01/15 Contact Derek Fall from bridge/fatality phone Supervisor 1 05/01/15 Defusing Derek Fall from bridge/fatality phone Supervisor 1 05/02/15 Defusing Lori child assault by dog in person PC 2 05/04/15 Contact Bill Lang FF suicide in person coordinator 1 05/04/15 Bill Lang intro to CISM-NEO in person 12 05/05/15 Contact Gary Laurent Personal phone Supervisor 1 05/05/15 Contact Jody Officer MVC in person PC 3 05/05/15 Defusing Gary Laurent Personal phone PC 1 05/07/15 Defusing Alice' Hall Critical Pediatric in person PC 1 05/07/15 Follow-up Gary Laurent Personal phone PC 1 05/14/15 Contact Jody TBGJ + Hanging phone PC 2 05/18/15 Aaron in person 05/21/15 Defusing Bill Lang employee 2 05/26/15 Follow-up Bill Lang in person 2 05/30/15 Contact in person PC 2 05/30/15 Defusing Alice' Hall in person PC 2 06/01/15 Contact Julie Bolt in person 1 06/01/15 Defusing Julie Bolt in person 2 06/10/15 Defusing Alice' Hall in person 2 06/11/15 Follow-up Alice' Hall 2 06/13/15 Defusing Lori phone 1 06/16/15 Contact Gary Laurent pediatric assault in person PC 1 06/17/15 Aaron intro to CISM-NEO in person 06/18/15 MHP Ride along Alice' Hall in person 06/19/15 Contact Bill Lang job related stress in person employee 1 06/23/15 Defusing Ed Palmer in person Supervisor 1 06/23/15 Offer Justin Gold (Sup) in person Supervisor 1 08/24/15 Bill Lang Intro to CISM NEO in person 25 09/22/15 Defusing Alice' Hall SIDS in person 1 09/24/15 Contact Mark Jones murder of adolescent phone Supervisor 1 09/24/15 Defusing Mark Jones murder of adolescent phone Supervisor 1 09/25/15 Defusing Bill Lang murder of adolescent in person employee 2 09/28/15 Follow-up Bill Lang murder of adolescent phone PC 1 10/01/15 Follow-up Bill Lang murder of adolescent in person PC 1 10/12/15 Contact Mark Jones pediatric code phone Supervisor 2 10/15/15 Defusing Jeff Beck Cumulative stress in person employee 1 10/17/15 Contact Mark Jones pediatric code phone Supervisor 1 10/17/15 Defusing Mark Jones phone Supervisor 1 10/20/15 Defusing Bill Lang ambulance wreck phone PC 2 10/24/15 Defusing Jody deteriorating patient in person Supervisor 1 10/25/15 Defusing Jeff Beck murder in person employee 1 10/28/15 Contact Derek rape phone 1 10/29/15 Follow-up Derek rape phone 1 11/02/15 Follow-up Bill Lang ambulance wreck phone PC 2 11/18/15 CISM Team Meeting 12/04/15 Defusing Bill Lang in person employee 2 12/15/15 Offer Tim Case (Sup) in person Supervisor 2 12/16/15 Defusing Derek SIDS in person employee 2 Pre Incident Ed. ped code Stekhuizen Stekhuizen Moorison Pre Incident Ed. Caprino Caprino Pre Incident Ed. Botteron Intro to CISM-River Rescue code/poor outcome-hsptl staff in person code/poor outcome-hsptl staff in person pc Lori MoorisonMoorison ped code ped code Ped drowning + kidnap/assault Ped drowning + kidnap/assault Moorison Ped drowning + kidnap/assault Pre Incident Ed. Botteron Drew Prochniak, LPC ped code ped code Pre Incident Ed. Caprino Stekhuizen training offic. Stekhuizen pc ped hospice pt ped code Stekhuizen
- 9. Mock CISM Activation Scenario Medic 51 responds to a Murder/Suicide involving a child. The on duty supervisor hears the call dispatched (or is notified by an astute dispatcher or other personnel). The Supervisor instructs the dispatcher to keep Medic 51 out of service after the call. The supervisor contacts the Medic 51 after the call to offer CISM services or simply keeps the crew out of service if critical incident exposure is obvious. If a CISM Activation is indicated the supervisor refers to the CISM Team Roster to identify a Peer Counselor who is on duty. The Supervisor then puts the Peer Counselor's unit out of service, contacts the Peer Counselor and offers as much information about the incident as is available. The Supervisor then arranges for private meeting space for a Defusing. The Peer Counselor meets with the crew and follows (as much as possible) the SAFER-R Model of Crisis Intervention (See the International Critical Incident Stress Foundation for an explanation of the SAFER-R Model, icisf.org) and assists the crew with understanding stress symptoms, making a self care plan, and referral to the MHP if indicated. The PC provides the crew with Critical Incident Stress Information Sheet (handout) and contact information for the MHP. The PC then offers to make a follow up call within one week. The crew and the PC decide if the crew will be relieved of duty for the remainder of the shift or go back in service. (AMR pays out the entire shift if the crew remains out of service after a critical incident so the crew does not suffer a loss in pay). The PC reports the work status of the crew to the activating supervisor and reports a CISM activation to the CISM Program Coordinator.
- 10. Components for Future Development Annual Line Item Budget: Establish a reoccurring line item in the budget the status of which is made available to the Coordinator. Funding was allocated in the first year of operation of the program. Subsequent funding has has been procured on an as needed basis. Funds used to cover program expenses are referred to as soft money, and are taken from other budgets. Including CISM in the budget would strengthen institutional support for employee mental health. Program Coordinator Position: Transition the Program Coordinator position from an add-on role to a 0.5 to 1.0 FTE position. Adding an undefined position such as CISM Coordinator to a full time field position has proven to be a challenging enterprise which may not be sustainable. Communications Center Utilization for Activation: Re-evaluate the feasibility of involving Dispatchers and Communications Center Supervisors in the identification of critical incidents and activation of Peer Counselors. Lending Library: Develop a free lending library focused on mental health, self care, peer support, and spiritual health maintenance. This would fulfill part of the pre-incident education objective of the program. Consultation Room: Establish a neutral space at each Operations Center which is quiet, comfortable, and provides privacy without interruptions for Defusing meetings. This room could house the lending library. Resources for CISM Team Maintenance: Develop resources for the team to strengthen relationships, improve personal mental health, and provide continuing education such as attendance at relevant conferences, in-services, and retreats. West Coast Post-Trauma Retreat: Establish a fund to provide scholarships to attend this retreat in California for those in the workforce who are significantly effected by Critical Incident Stress. Annual Mental Health Check-up: Develop resources to encourage each employee to see a MHP once each year for a general mental health check-in and check-up. This practice is being encouraged among law enforcement personnel and could be likened to annual medical check-ups as a mental health maintenance measure. This one hour appointment could earn CME credits if approved by the MPD.